Dogan Ozgur, Caliskan Emrah, Duran Semra, Bicimoglu Ali
Orthopaedics and Traumatology Department, Numune Training and Research Hospital, Ankara, Turkey.
Radiology Department, Numune Training and Research Hospital, Ankara, Turkey.
Acta Orthop Traumatol Turc. 2019 Sep;53(5):351-355. doi: 10.1016/j.aott.2019.05.004. Epub 2019 Jul 26.
The aim of this study was to measure the cartilaginous coverage of the acetabulum using magnetic resonance imaging (MRI) and to analyze its effect on the timing and necessity of secondary operations in residual acetabular dysplasia (RAD).
The MRI results of 33 children (30 girls and 3 boys) aged between 5 and 9 years who were operated on unilaterally via a posteromedial limited approach were compared with the radiographical findings of acetabular dysplasia at follow-up. The acetabular index (AI) and the center-edge (CE) angles were measured. MRI was used to measure the osseous acetabular index (OAI), cartilage acetabular index (CAI), and cartilaginous center-edge angles (CCE). The Children's Hospital's Oakland Hip Evaluation Score (CHOHES) was used for the assessment of clinical and functional results. The Severin scoring system was used to evaluate the radiographic results. The Mann-Whitney U test and Spearman correlation tests were used for statistical analysis.
In all, 30 (90.9%) girls and 3 (9.1%) boys with an average age of 7.4 years (range: 5-9 years) and a mean follow-up period of 6.1 years (range: 4-8 years) were included. While there was a significant difference between non-dislocated hips and operated hips in 3 measurements (AI, Wiberg CE, and Ogata CE) using X-rays (p < 0.05), no significant difference was found in the MRI measurements (OAI, CAI, and CCE) (p > 0.05). The CAI values were lower than the AI measured on X-ray (p = 0.035). The mean CCE was higher than the mean CE (p = 0.022). The mean CHOHES score was 83.1 (range: 52-100) and the score of 62% patients was above 90. There was no significant difference in terms of CHOHES score according to age at the time of operation (p = 0.43). Three (9.1%) patients were Severin class I, 8 (24.3%) patients were class II, 12 (36.3%) patients were class III and 10 (30.3%) patients were class IV. There was no correlation between preoperative hip dislocation and Severin score (p = 0.056). No significant difference was found between the ambulatory and non-ambulatory groups in terms of Severin classification (p = 0.063).
Cartilaginous acetabulum should be taken into account in RAD measurements. MRI may be a more appropriate option for the evaluation of acetabular cartilaginous coverage in the evaluation of RAD and the decision to perform surgery, though X-rays are currently the most used method. The results revealed no effect on functional or radiological scores as a result of being of walking age.
Level III, Diagnostic Study.
本研究旨在利用磁共振成像（MRI）测量髋臼的软骨覆盖情况，并分析其对残余髋臼发育不良（RAD）二次手术时机和必要性的影响。
将33例年龄在5至9岁之间、通过后内侧有限入路进行单侧手术的儿童（30例女孩和3例男孩）的MRI结果与随访时髋臼发育不良的X线检查结果进行比较。测量髋臼指数（AI）和中心边缘（CE）角。MRI用于测量骨性髋臼指数（OAI）、软骨髋臼指数（CAI）和软骨中心边缘角（CCE）。采用奥克兰儿童医院髋关节评估评分（CHOHES）评估临床和功能结果。采用塞韦林评分系统评估X线检查结果。采用曼-惠特尼U检验和斯皮尔曼相关性检验进行统计分析。
共纳入30例（90.9%）女孩和3例（9.1%）男孩，平均年龄7.4岁（范围：5至9岁），平均随访时间6.1年（范围：4至8年）。虽然在使用X线进行的3项测量（AI、维伯格CE和绪方CE）中，未脱位髋关节与手术髋关节之间存在显著差异（p<0.05），但在MRI测量（OAI、CAI和CCE）中未发现显著差异（p>0.05）。CAI值低于X线测量的AI值（p=0.035）。平均CCE高于平均CE（p=0.022）。CHOHES平均评分为83.1（范围：52至100），62%患者的评分高于90分。根据手术时年龄，CHOHES评分无显著差异（p=0.43）。3例（9.1%）患者为塞韦林I级，8例（24.3%）患者为II级，12例（36.3%）患者为III级，10例（30.3%）患者为IV级。术前髋关节脱位与塞韦林评分之间无相关性（p=0.056）。在塞韦林分类方面，行走组与非行走组之间未发现显著差异（p=0.063）。
在RAD测量中应考虑软骨髋臼。尽管X线目前是最常用的方法，但在评估RAD和决定是否进行手术时，MRI可能是评估髋臼软骨覆盖的更合适选择。结果显示，达到行走年龄对功能或放射学评分没有影响。
III级，诊断性研究。
